Imaging Pearls ❯ Esophagus ❯ Boerhaave Syndrome
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- “Spontaneous esophageal perforation (Boerhaave syndrome) is a very uncommon, life-threatening surgical emergency that should be suspected in all patients presenting with lower thoracic-epigastric pain and a combination of gastrointestinal and respiratory symptoms. Variable clinical manifestations and subtle or unspecific radiographic findings often result in critical diagnostic delays. Multidetector computed tomography complemented with CT-esophagography represents the ideal “one-stop shop” investigation technique to allow a rapid, comprehensive diagnosis of BS, including identification of suggestive periesophageal abnormalities, direct visualization of esophageal perforation and quantification of mediastinitis.”
Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography Massimo Tonolini, Roberto Bianco J Emerg Trauma Shock. 2013 Jan-Mar; 6(1): 58–60 - “Multidetector computed tomography complemented with CT-esophagography represents the ideal “one-stop shop” investigation technique to allow a rapid, comprehensive diagnosis of BS, including identification of suggestive periesophageal abnormalities, direct visualization of esophageal perforation and quantification of mediastinitis.”
Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography Massimo Tonolini, Roberto Bianco J Emerg Trauma Shock. 2013 Jan-Mar; 6(1): 58–60 - “Unless specifically considered in the differential diagnosis, spontaneous esophageal perforation is often unsuspected or misdiagnosed, since its manifestations closely mimic other more common intrathoracic diseases, including myocardial infarction and pericarditis, acute aortic disease or even abdominal emergencies such as perforated peptic ulcer or acute pancreatitis. Unfortunately, diagnostic work-up delays may hinder timely treatment with a negative effect on patients’ outcome.”
Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography Massimo Tonolini, Roberto Bianco J Emerg Trauma Shock. 2013 Jan-Mar; 6(1): 58–60 - “Although controversy exists about appropriate therapy, surgical management is currently considered the gold standard for ruptures diagnosed within 24 hours from onset and allows a 75% chance of recovery. Surgery should include pleural cavity drainage, perforation debridement and primary repair through an open thoracotomic or laparoscopic approach. Conservative management with resuscitation and broad-spectrum antibiotics should be reserved for patients with minimal sepsis and mediastinal abnormalities, and for those too unstable to undergo surgery. After 24 hours, survival rates as low as 20% have been reported, therefore a high index of clinical suspicion and prompt diagnostic assessment are needed.”
Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography Massimo Tonolini, Roberto Bianco J Emerg Trauma Shock. 2013 Jan-Mar; 6(1): 58–60 - “ Mediastinal findings suggestive of esophageal injury and associated mediastinitis (such as periesophageal and mediastinal gas and/or mediastinal fluid collections, esophageal wall thickening, pleural effusion or hydrothorax) are reliably identified on thoraco-abdominal emergency CT examinations performed under alternative clinical diagnoses.”
Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography Massimo Tonolini, Roberto Bianco J Emerg Trauma Shock. 2013 Jan-Mar; 6(1): 58–60 - “Clinical or CT features suggesting the diagnosis of BS should be further investigated by means of CT-esophagography with oral ingestion or administration through the nasogastric tube of 10% diluted iodinated contrast medium, and reconstruction of multiplanar images. Easily performed as a complement of initial CT acquisition, CT-esophagography allows to confirm and visually document the perforation through the direct identification of extraluminal contrast leakage. The time spared without transferring the patient from the CT scanner table to the fluoroscopic suite may prove prognostically important.”
Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography Massimo Tonolini, Roberto Bianco J Emerg Trauma Shock. 2013 Jan-Mar; 6(1): 58–60